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Not Every Man is Born with Two Testicles in the Scrotum

April 16, 2017 | 5:42PM ET


By Dr. Angelo D. Gousse

What are the main purposes of the Testicles ?

Not every man is born with two testicles in the scrotum ( sac) . The testicles (or "testes") are two reproductive solid organs that hang in a pouch-like skin sac (the scrotum) below the penis. The testicles are where sperm ( allowing a man to be fertile ) and testosterone (the male sex hormone) are produced. The scrotum keeps the testicles at a lower temperature ( cooler ) than the body to keep the cells functioning properly. This is because sperm can't grow and mature properly at body temperature. During childhood, sperm in the testicles go through a process that results in mature sperm at puberty. In most cases only one testicle is needed for normal testosterone production and adequate sperm count. The other testicle acts as a "spare" testicle. Similar to a "spare tire ".

Normal testicles form early inside the mother's womb, before birth . They form in the lower belly (abdomen), but descend, or "drop," into the scrotum toward the end of pregnancy. Normal testicles attach themselves with stretchable tissue in the bottom of the scrotum. The normal descent of the testicles is controlled by the baby's normal hormones and body chemistry.

How Common are Undescended Testicles ?

An undescended testicle (or "testis") is when it fails to drop into the normal position in the scrotum. Your child's health care provider can find this during a routine exam or you may discover that while examining your baby. The testicles fail to descend in the scrotum in approximately 3 or 4 out of 100 newborns- 4 % (and up to 21 out of 100 21 % premature newborns). Therefore premature babies are at greater risk for undescended testicles.

Fortunately, approximately 50% of these testicles will drop on their own during the first 3 months of life. But testicles ordinarily do not drop on their own after 3 months of age. Thus, about 1 or 2 out of 100 boys with undescended testicles will need treatment.

It's important not to confuse undescended testicles with "retractile" testicles. After 6 months of age, a male child has a reflex that temporarily pulls the testicles up to protect them when he's cold or frightened. Once the room temperature normalizes, the testicle goes back to its normal position in the scrotum. These testicles are in the scrotum at other times and don't need treatment. That is why it is better to examine infants and children scrotum in rooms that are not too cold.. Only testicles that are truly undescended and never make it to the scrotum need treatment. A good clinician can tell the difference with a physical exam.

The testicles need to be 2 to 3 degrees cooler than normal body temperature to make sperm. The scrotum is many degrees cooler than body temperature, and so is the ideal place for the testicle. Testicles that don't drop into the scrotum won't work normally. The longer the testicles are too warm, the lower chances are that the sperm in that testicle will mature normally. This can be a cause of infertility, especially when both testicles are affected.

Undescended testicles are also linked to a higher risk of:

o Testicular cancer in adulthood (though the risk is still less than 1 in 100)
oTesticular torsion (twisting of the chord that brings blood to the scrotum)
oDeveloping a hernia near the groin
What about Missing Testicles ?

A testicle that can't be felt in a physical exam is called "nonpalpable." Nonpalpable testicles may be in the abdomen (undescended), absent, or very small ("atrophic"). In other words , sometimes the testicle is never formed or developed inside the mother's womb. It's important to find out whether there is a testicle that hasn't dropped. An undescended testicle left inside the abdomen could form a tumor later in life. Such a tumor might not be noticed until it becomes quite large or causes symptoms. Unfortunately, there's no test, such as an ultrasound, that can definitively show whether a testicle is in the abdomen .Exploratory surgery is the only way to find out for sure whether the testicle is in the abdomen or never developed ( "vanished" ).

Pediatric urologists are experts in both open and laparoscopic surgery. Laparoscopy is surgery done through thin tubes put into your child's body through a small cut. The surgeon uses a special camera to see inside your child's body. The surgeon will find one of 3 situations:

1. Blind-ending testicular blood vessels - proving there's no testicle
2. Vessels leaving the abdomen - proving there's no testicle in the abdomen
3. A testicle in the abdomen. If a testicle is found, it's brought down into the scrotum or removed, based on its condition.
How are Undescended Testicles Treated?

The testicle won't drop after 3 months of age, so the only treatment choice is surgery. Surgery is recommended after 6 months of age. The timing takes into account when the child is able to handle anesthesia and the surgery. Drugs or hormone treatment aren't useful.

This surgery is called an orchiopexy. The child is put under (general anesthesia) for this surgery. Almost always the child can go home the same day and is back to normal within 1 to 2 days. A cut about 1 inch long is made in the groin area (most often it can hardly be seen later). The testicles is freed from all nearby tissues so that it moves easily into the scrotum. Then it is stitched into place. If there's a hernia, it's fixed at the same time. In some cases, the testicle is too high for this simple surgery. Overall, the success rate with surgery is 98 out of 100.

What Can I Expect after Treatment?

After treatment, the testicle often grows to normal size in the scrotum. In some cases, the testicle wasn't normal to start with, and never grows the right way. In other cases, sperm never grow, even though the testicle size is normal. In most cases, after treatment for undescended testicle, fertility becomes normal and the chances of fathering a child in the future are high. When the child becomes a teen, he should have routine physical exams and do monthly testicular self-exams. Routine physicals will look for signs of testicular cancer, which remains a slight risk in patients with undescended testicles.

Sources :1- www./urologyhealth.org,
2- Campbells Urology



Angelo E. Gousse, MD
Clinical Professor of Urology - Herbert Wertheim College of Medicine - FIU
Voluntary Professor of Urology - University of Miami , Miller School of Medicine
Director of Fellowship:Female Urology,Voiding Dysfunction, Reconstruction

Memorial Hospital Miramar, South Broward Hospital District
1951 SW 172 Avenue, Suite 305, Miramar, FL, 33029

Tel: 954-362-2720 Fax: 954-362-2761 www.bladder-health.net


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